Stereotactic thalamotomy has been reported to be effective in the control of various tremors, including essential tremor. We report a 69-year-old female who experienced spontaneous thalamotomy with a small thalamic hemorrhage, resulting in disappearance of essential tremor on the contralateral side to the hematoma, which involved the nucleus ventralis intermedius (Vim) of the thalamus and a portion of the posterior limb of the internal capsule.